HEART
January 18, 2017

Under 50 and Under-Treated

People in their 30s and 40s can have high LDL cholesterol, too. Yet often they don't get the treatment they need.

Cardiovascular disease (CVD) continues to be the leading cause of death in the US. People with very high levels of low-density lipoprotein cholesterol (LDL-C, or “bad” cholesterol) are especially at risk.

Treatment to lower LDL most often involves statin medications, which are recommended for adults 21 years old or older with LDL-C levels of 190 mg/dL or higher.

Ideally, treatment should begin before patients experience symptoms and risk factors for heart disease, such as diabetes.

Unfortunately, statins are prescribed for fewer than 45% of adults 40 years old and younger with high LDL-C levels, a new study has found. The investigators were surprised by their findings, but, as author David Zidar told TheDoctor in an email, “These results have implications we hope to capitalize on.”

Using data from 2,884,260 patients, the researchers found almost four percent had a LDL-C level of 190 mg/dL or higher. Statins were prescribed for only 32%, 47% and 61% of patients in their 30s, 40s and 50s respectively.

So why aren't statin medications prescribed to younger adults as commonly as they are for people over 60? Misconceptions among physicians and patients are likely part of it, said Zidar, a cardiologist at University Hospitals Case Medical Center. Younger patients tend to be healthy and active, Zidar pointed out, so physicians may be likely to tell them to lower their cholesterol levels through diet and exercise alone.

There's a patient side to it as well. Younger patients who are in their peak years of productivity usually have no symptoms and feel good. They are busy with work and family commitments, Zidar said, “So fewer opportunities for follow-up exist and there may be resistance on the part of both doctors and younger patients toward taking medications.”

True prevention requires that physicians identify younger people with high LDL-C levels, and treat them with statins as quickly as possible. Ideally, treatment should begin before patients experience symptoms and risk factors for heart disease, such as diabetes. Very high LDL-C levels are often the result of genetics, as opposed to lifestyle, so hopefully physicians can identify and treat siblings and children of patients at a young age.

The Harrington Heart and Vascular Institute at the University Hospitals in Cleveland will be initiating a program to engage patients and partner with them and their physicians, according to Zidar. “We hope we can better understand what the true barriers are and how our system of care can be tweaked to make it more efficient and effective for all patients at risk for heart and vascular disease.”

The study is published online in JAMA Cardiology.
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